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Sacopee Valley Birthing Services www.sacopeemidwives.org Serving women in southern Maine and eastern New Hampshire. Brenda Surabian, AEMT, CPM • Lindsay Bushnell, CPM, NHCM • Jodie Kaufman, CNM, NP • Robin Doolittle Illian, CPM [email protected] 207 .329.2111 Fax 207 . 591.4767 Varicosities in Pregnancy W hat are they? A varicosity, or varicose vein, is a part of a vessel where blood has pooled causing it to be swollen or distended. You may notice it as a purple/blue bulge. Varicosities occur when the valves that normally keep blood flowing one-way through the vessels become weak, which allows the blood to pool in the veins, and when veins become lax or weak. W here do they happen? Varicose veins occur most commonly on the legs, the vulva (called vulvar varicosities), and anus (called hemorrhoids). W hy do they happen? There are a variety of factors that can lead to someone developing varicosities. Heredity has a lot to do with it, most likely your mother or grandmother had them as well. Also, deficiencies in the diet can play a role. Nutrient-rich food is very important for maintaining strength in the walls of blood vessels. Vitamin C, bioflavanoids, Vitamin E, and Vitamin B complex as well as plenty of essential fatty acids are all integral parts of healthy blood vessels (see info below on foods with these nutrients). Factors of pregnancy play a huge role in the development of varicosities, as many of the normal body changes in pregnancy create a good environment for varicose veins. First, blood volume expands in pregnancy and adds an extra load to vessels that are already relaxed by the increased levels of the hormone progesterone (which is normally high in pregnancy compared to other times in life). Progesterone relaxes smooth muscle in general (also the culprit for heartburn) and impairs venous return of the blood. Also, pressure of the enlarging uterus and baby on the pelvic veins reduce blood return and can increase the chances of blood pooling. Prolonged periods of standing can add to the problem. W hat does having varicosities mean for the rest of pregnancy? With no treatment, varicosities tend to become more pronounced as pregnancy continues. With treatment, however, enlargement can be slowed or prevented. Most of the time varicosities resolve after pregnancy, though many women will have less pronounced non-pregnant varicose veins, but not have them completely disappear. Varicosities do not affect your baby, or your ability to birth your baby. Hemorrhoids and vulvar varicosities often enlarge during the second stage of labor (pushing phase). A slow, gentle birth and hot compresses applied to the distended veins usually prevent trauma to them. Occasionally, bleeding or a hematoma (an internal pooling of blood from a broken vessel) can result and may require medical care. If you have varicosities in one pregnancy, you are likely to develop them again in future pregnancies. Following the guidelines below as soon as you know you are pregnant next time and keeping up with the dietary and lifestyle modifications can prevent their return. W hat are my treatment options? There are many! I have grouped them into categories. Do at least one thing in each category. I have starred what I consider most important. Many of them are healthy lifestyle adjustments that will not only help with your varicosities, but bring you a myriad of health benefits. Diet for Varicosities: • A diet rich in healthful foods, especially a variety of whole grains, high-quality protein (meats, beans, eggs, cheese, nuts), and lots of vegetables will supply you with all the nutrients you need for the maintenance of a healthy circulatory system. • *Eat foods rich in— o Vitamin C (Vital for maintaining strength in the walls of blood vessels and can be found in citrus fruits, rose hips, dark leafy green vegetables like kale and collards, cherries, alfalfa sprouts, strawberries, cantaloupe, broccoli, tomatoes, and green peppers.) o Bioflavanoids (Also strengthens vessels and are found with vitamin C and found especially in all dark berries and the white pithy coating of citrus. Also in lemons, grapes, plums, black currants, grapefruit, apricots, buckwheat, and blackberries.) o Vitamin E (This vitamin works by dilating blood vessels, thus directly facilitating the blood flow. It’s found in nuts, high quality oils, wheat germ, spinach, asparagus, prunes.) o Vitamin B complex (Again, necessary for healthy veins. Found in whole grains including oatmeal, wheat germ, whole grain breads, quinoa, organ meats, nutritional yeast, fish, mushrooms, lentils, eggs.) o Vitamin A (For overall vascular health. Found in liver, fish oil, butter, egg, spinach, orange and yellow vegetables such as carrot, squash and sweet potato.) o Essential fatty acids (A deficiency of essential fatty acids may make varicose veins worse. They are found in avocado, fish, fish oil, coconut oil, olive oil, farm fresh eggs.) • Onions and garlic have components that help veins to maintain or regain elasticity. Eat them daily in your meals. • *Just for emphasis… Did I say dark leafy greens? They are so important and should be included in the diet on a daily basis. Some choices are; kale, collards, mustard greens, dandelions greens, spinach, chard, romaine lettuce, or green or red leaf lettuce (skip the iceburg lettuce and get something darker.) Exercise for Varicosities: Exercise can vastly improve circulation, getting blood moving out of those pooled areas. By increasing your circulatory rate during exercise you are effectively removing stagnation in your blood vessels and directly reducing blood congestion, a primary factor in varicosities. Exercise is a vital part of the treatment and prevention of varicosities. • *Take a brisk walk for twenty to thirty minutes a day • Swimming is a great exercise for the circulatory system. Find an indoor pool during the offseason, take advantage of the lakes or ocean in summer, and swim for 30 minutes three times per week, or whenever you can. • • Inverted yoga postures help move your blood out of the stagnated lower half. Choose from the following, or do them all— o Legs up the wall (for varicosities in the legs). Lie on your back with your bottom against the wall. Put your legs up against the wall. Hang out here for 10-15 minutes. o Incline position. This one is good for vulvar varicosities as it elevates the hips. To be in a true incline it helps to prop an ironing board against the edge of the bed or couch. Lie on the board with your feet up. Doing this once a day can help take the pressure off. o *Hip elevations (for vulvar varicosities). Simply lie in a comfortable spot with pillows under your hips to elevate them. Keep your back on the ground/bed. o Shoulder stand (if this is a yoga pose that you have done before pregnancy). *Kegel Excercises! For vulvar varicosities and hemorrhoids do kegels throughout the day (aim for 100 per day. Start by doing 5, 5 times per day. Work up to 10, 10 times per day). These help to increase circulation in the area and keep the blood moving (along with other benefits). To do a “kegel” you contract and then relax your pubococcygeous (PC) muscle. To find your PC muscle contract the muscles to stop yourself from urinating while mid-stream. Don’t make a habit of practicing them while urinating, as it can contribute to a UTI. Internal Treatments for Varicosities: • *Homeopathic Hamamelis pellets. 3 times/day. • *Supplements of Vitamin C w/ Bioflavanoids (up to 1000mg/day), and/or Rutin capsules (this is a bioflavanoid specific to vessels. Found at a health food store. Not recommended in first trimester.) • Vitamin E supplement, between 200-600 IU per day. • Fish oil supplement (like a high quality cod liver oil or salmon oil. Evening Primrose oil is another good one for the last month of pregnancy only.) • *Nettles. This herb has been touted as the “best herb for pregnant women with varicose veins” by herbalist and midwife Aviva Jill Romm. It is high in minerals and is astringent, which helps to tonify vessels and improve elasticity of the veins. Nettles are also a great source of absorbable iron and calcium, strengthen and support the kidneys, and is an all around excellent pregnancy tonic. Drink 2 cups to one quart per day of nettle infusion (1/2 cup of dried nettle in the bottom of a quart jar. Top with boiling water, cover, and let sit overnight or at least 4 hours. Strain. Refrigerate what you are not drinking. Lasts 2 days in the fridge.) External Treatments for Varicosities: • *Apply witch hazel (available at drug stores) to varicose veins on the legs with a cloth. For vulvar varicosities, soak a cloth with witch hazel and apply it directly to the area. This could be done while lying with your hips elevated. Do this daily, or as needed. • Herbal sitz baths with astringent and healing herbs for vulvar varicosities (some suggested herbs are comfrey, yarrow, goldenrod, calendula, witch hazel bark, oak bark, bayberry bark or mullein). Three times per week, or as needed for comfort. • Ice packs can be soothing Other Suggestions: • *Avoid long periods of standing. Sit instead of stand whenever possible. • Take rest periods during the day, sitting with legs (or lying with hips) elevated. This is as important as exercising once a day. Make the time to do both! • Keep your legs uncrossed when sitting. • • • Support hose, ace bandages, or elastic stockings for leg varicosities can help tremendously with discomfort. These should be put on after elevating legs and before standing up. There are support items for vulvar varicosities such as the “Prenatal Cradle” or the V-Brace by Fembrace. These are available online (prenatalcradle.com or fembrace.com). You could also try providing physical support for vulvar varicosities by wearing bicycle shorts or wearing a thick pad against the varicosities. If varicosities get really severe, surgery is an option after pregnancy. Consult your doctor.